背景:抗生素管理计划(ASP)改善了革兰氏阴性血流感染的经验性和针对性抗生素治疗。死亡率下降,重新接纳,和住院时间已报告。
方法:在2015年11月至2016年4月(干预前)之间进行了一项准实验研究,2016-2017年、2017-2018年和2018-2019年(干预后),为了分析ASP对实证的影响,directed,和整个治疗优化,以及死亡率,重新接纳,以及住院时间,在革兰阴性杆菌(GNB)血流感染的住院患者中。
结果:纳入了一百七十四名患者(干预前的41名,第一年干预后组有38人,干预后第二年组50人,和45在第三年后干预组)。定向治疗优化有显著改善(干预前治疗组为43.9%,干预后第一年组的68.4%,干预后第二年组的74%,干预后第三年组的88.9%,P<0.001),以及整个治疗优化(19.5%,34.2%,40.0%,和46.7%,分别,P=0.013),具有增加的最优定向(调整后的赔率比[AOR],3.71;95%置信区间[CI],1.60-8.58)和整个治疗(aOR,3.31;95%CI,1.27-8.58)。尽管在ASP实施后的经验处理中观察到了改进的趋势,没有达到统计学意义(41.5%vs.57.9%,P=0.065)。死亡率没有变化,重新接纳,或检测到住院时间。
结论:ASP的实施随着时间的推移改善了GNB血流感染患者的定向和整体治疗优化。然而,在临床结局如死亡率方面没有发现改善,重新接纳,或住院时间。
BACKGROUND: Antibiotic Stewardship Programs (ASP) have improved empirical and directed antibiotic treatment in Gram-negative bloodstream infections. A decrease in mortality, readmission, and length of hospitalization has been reported.
METHODS: A pre-post-quasi-experimental study was conducted between November and April 2015-2016 (pre-intervention period), 2016-2017, 2017-2018, and 2018-2019 (post-intervention periods), to analyse the impact of ASP on empirical, directed, and entire treatment optimization, as well as mortality, readmission, and length of hospitalization, in hospitalized patients with Gram-negative bacilli (GNB) bloodstream infections.
RESULTS: One hundred seventy-four patients were included (41 in the pre-intervention group, 38 in the first-year post-intervention group, 50 in the second-year post-intervention group, and 45 in the third-year post-intervention group). There was a significant improvement in directed treatment optimization (43.9% in the pre-intervention group, 68.4% in the first-year post-intervention group, 74% in the second-year post-intervention group, and 88.9% in the third-year post-intervention group, P <0.001), as well as in entire treatment optimization (19.5%, 34.2%, 40.0%, and 46.7%, respectively, P=0.013), with increased optimal directed (adjusted odds ratio [aOR], 3.71; 95% confidence interval [CI], 1.60-8.58) and entire treatment (aOR, 3.31; 95% CI, 1.27-8.58). Although a tendency toward improvement was observed in empirical treatment after ASP implementation, it did not reach statistical significance (41.5% vs. 57.9%, P=0.065). No changes in mortality, readmission, or length of hospitalization were detected.
CONCLUSIONS: ASP implementation improved both directed and entire treatment optimization in patients with GNB bloodstream infections over time. Nevertheless, no improvement was found in clinical outcomes such as mortality, readmission, or length of hospitalization.